Cape Town - A call has been made for explicit and, ideally, government-backed policies to support countless people providing care to people living with HIV and AIDS amid reports that many care givers are neither officially known nor rewarded for their work in Southern Africa.

'Very often when people talk about care workers in the SADC region they talk about nurses, doctors and other people employed at health facilities.

'They do not talk about people providing care in the shadows: home-based caregivers like mothers, wives, sisters, grandmothers, grand children and others looking after people living with HIV,' Ms Loga Virahsawmy, GEMSA regional chairperson, said in a recent interview.

With approximately two in five of all people infected with HIV globally in the past few years, Southern Africa is now regarded the epicenter of the global HIV pandemic.

Experts say HIV and AIDS disproportionately affects women and girls, who also form the overwhelming majority of people providing care and support to people infected and affected by the pandemic.

Loosely defined, care workers are people who help the sick or infirm.

The majority of care workers in Southern Africa provide home-based care for people living with HIV, often without being paid.

Virahsawmy explained that caregivers may be close family members such as children, wives or sisters socially or culturally expected to nurse the sick, or may be associated with organizations (such as NGOs) or linked to government-run health facilities.

She said recently the Gender and Media Southern Africa (GEMSA) Network audited care work policies in 12 countries that are members of the Southern African Development Community to establish the extent to which care work was recognized in those countries.

She was optimistic that the study would deepen and broaden the understanding of the challenges and needs of care givers all over the region.

The Southern Times has obtained a copy of the audit, which shows a serious dearth of laws and policies with respect to care work in six of the audited countries.

The audit was conducted in Botswana, the Democratic Republic of Congo, Lesotho, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe.

The audit says Namibia has an 'excellent community home-based care policy'.

'The new CHBC policy calls for a monthly incentive of N$250 – N$500 (roughly US$31-62). Under the new policy, all caregivers will require an identity card; T-shirt; shoes; umbrella; a home-based care kit; some form of transport; communication funds; and a monthly monetary incentive…the government will re-train all care givers using a standardized manual.

'Government will accredit those who pass the training through the Namibian Qualifications Authority,' says the audit of Namibia.

It adds that the new policy would address the psychological needs of care givers and encourage men to get involved in care work.

In Botswana, no clear policy on care work exists and the government is not keen on paying caregivers, arguing that incentivizing care work would compromise the spirit of volunteerism.

That being the case, only donor organizations provide financial incentives while the government provides volunteers with transportation allowances of P151 (about US$22) per month and clinical supplies.

At the time of the audit there was no stipulated minimum training for volunteer caregivers.

Training provided to them by nurses lasted about a week followed by refresher courses should new issues have arisen.

In Tanzania care work was not recognized as a profession and there was no policy with respect to payment of caregivers.

Gender equality also appears not to be a prime issue in the sector.

The Zimbabwe audit found that the government also had no policy on gender policy and payment of caregivers.

However, new guidelines recommended incentives that included uniforms, bicycles, food packs, monetary allowances, free medical treatment, support for income generating projects, part-time jobs in hospitals and funeral assistance.

The guidelines also espouse training on basic care.

Mr. Mike Podmore, who is based at the Voluntary Services Overseas headquarters in London where he works as an HIV policy and advocacy advisor said women and girls remained the unsung heroines in the response to HIV.

'Home-based care is one of the great, invisible and forgotten responses to the HIV and AIDS pandemic across the world but especially so in Southern Africa where the pandemic is generalized.

'The region is the epicenter of the HIV pandemic. Home-based care is the care and support mostly provided by women and girls in the community; either by family or loved ones or within community-based organizations by community volunteers,' Podmore said.

He said most caregivers – whether in the home or working for community organizations – worked each and every day of the week, looking after between 10 to 20 people each.

'They walk long distances between their clients. They provide care for them in their homes, often with little or no training and with very little equipment.

'For example, only a few of the home-based carers have access to home-based kits or equipment like gloves or simple things like soap.

'If they want those things they have to pay for them out of their pockets. An awful lot of carers are doing this. Most carers are made poorer by what they do.'

He said research on home-based care is still very limited and stressed the need for a deeper and broader l understanding of the lives of volunteers and the level to which they receive remuneration for what they do or what it costs them to deliver.

However, Podmore said there are some studies that are beginning to give a better understanding of home-based care.

One of them was done by Voluntary Services Overseas-RAISA and the World Health Organization's Africa office.
That research was conducted across six Southern African countries and included interviews with the caregivers and other key stakeholders.

The study came up with several recommendations targeted at governments and civil society.

'The idea is to make home-based care visible, properly supported and resourced. The second study was conducted by the Huwai Commission with funding from the United Nations Development Programme.

'This is a network of women's organizations globally. They interviewed nearly 2 000 carers across six southern and eastern Africa in 2009.'

On the key findings of that research, Podmore said: ' They asked the care givers if they had received any training.

'Only two-thirds had received any training at all and half of those had received once-off training. Only seven percent of all those interviewed were receiving any form of stipend or monetary recompense for the work they did.

'The interviews covered a whole range of issues including access to training, equipment and it gave us a good insight into what the issues were.'

Podmore said policies need to be improved so that more resources are made available to community and home-based programmes; both funding the formal health sector and providing the resources and support to people who have been providing home-based care on their own for such a long time.

'There is need to re-look at human resources for health; ensure that men are getting involved in care work and challenging gender norms in that respect; creating a link between nurses and doctors as well as community and home-based carers on the ground so that support is given to those carers.

'Nurses and doctors can hopefully pass on less complex duties to the care givers.'

Indications are that the involvement of men in care work has been very minimal, with some reports suggesting the few that get involved prefer clerical or administrative roles.

While conceding that bringing more men on board is not easy, Pomore was optimistic that it could be done.

'There are short-term and long-term approaches. Short-term approaches entail engaging men very specifically; perhaps by identifying tasks related to home-based care that they might feel comfortable doing given the traditional roles for men and women.'

He suggested this might involve some lifting, fetching or cutting of firewood and opined that giving men some sort of stipend might draw them into the sector.

A long term approach would entail redefining or understanding what it means to be a man or a woman.

'It involves talking to men and young boys about their conception of being male while showing them that it is important for them to get involved in care work.'

Podmore said schools and other agents of socialization would have to be roped in. 'This is challenging gender norms. It has to begin at school. By the age of 19 or 20 men have already formed a lot of their understanding of who they are, what they should or should not be like.

'This is not to suggest that men at that age are unreachable. I am just saying at that age there is a lot of dismantling to be done before one can rebuild new attitudes. Schools are the best place to start.'

Virahsawmy and Podmore spoke as 20 parliamentarians from Angola, Malawi, Mozambique, Botswana, Namibia, South Africa, Swaziland and Zimbabwe, as well as representatives from seven NGOs met in Cape Town to discuss the burden of care work on women and girls.The SADC Parliamentary Forum organized the one-day workshop in collaboration with VSO-RAISA. The workshop called for more research into the contribution and plight of caregivers and for policies and laws to support care work and care givers.

The Nelson Mandela Childrens Fund (NMCF) has, through the Goelama Programme since 2002,
funded non-governmental organisations to support orphans and vulnerable children. The focus has
been on strengthening households and support systems for orphans and vulnerable children (OVC),
promoting behaviour change to prevent further spread of HIV, and enhancing integration with local
government services. Based on the fact that many children, including orphans, are dying of AIDS,
without appropriate palliative care, an expansion of the NMCF Goelama approach is being developed.
This is a collaboration between the Diana, Princess of Wales, Memorial Fund, the NMCF and the Hospice
Association of South Africa.

Swaziland's home-based caregivers are too few and too poorly paid to
cope with the growing numbers of bedridden AIDS patients, but in the
absence of adequate health facilities and trained professionals, they
are seen as the immediate answer to a national emergency.